NRSG139: Reflective Analysis of NMBA Standard 4 in Nursing Practice

This essay provides a reflective analysis of a nursing scenario based on a video, using Gibbs' Reflective Cycle and focusing on Standard 4 of the Nursing and Midwifery Board of Australia (NMBA) and the Nursing Competency Assessment Schedule (NCAS), which emphasizes comprehensive patient assessment. The reflection covers the description of the event, personal feelings, evaluation of the nurse's actions, analysis of what went well and what went wrong, conclusion on the importance of holistic assessment, and an action plan for improving assessment skills. The essay identifies shortcomings in the nurse's assessment in the video, particularly in not conducting a comprehensive and holistic evaluation of the patient's condition, and emphasizes the need for nurses to develop clinical skills to adhere to NMBA Standard 4, including utilizing various assessment methods and identifying early warning signs.

Running head: Nursing 139
Nursing 139
Name of the Student
Name of the University
Author Note

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Introduction:
In this assignment, a nursing scenario depicted on a video (“NRSG139 Ax3
TPRVignette”) is analyzed through the structured approach of a Gibbs Reflective Cycle
(YouTube, 2018). The analysis is broken down into the components of the reflective cycle,
that is: 1. Description, 2. Feelings, 3. Evaluation, 4. Analysis, 5. Conclusion and 6. Action
Plan (Husebø et al., 2018). The analysis will be based upon Standard 4 of the NMBA
(Nursing and Midwifery Board of Australia) and NCAS (Nursing Competency Assessment
Schedule) which focuses on the practice of comprehensive assessment of the patient and
patient’s condition. This standard is a part of 7 inter related standards of
professional/registered nursing practice recommended by the NMBA and NCAS to ensure
the best practice standards in nursing (nursingmidwiferyboard.gov.au, 2018).
The Standard 4 (Comprehensively conducts assessments) includes 4 aspects: 1.
conducting holistic and culturally appropriate assessments, 2. Using a range of assessment
techniques in order to collect data in a systematic way and inform professional practice, 3.
Working in partnership in order to identify aspects which can affect the health and wellbeing
of the clients and identifying priority action areas and/or referrals, 4. Assessment of the
available resources and including them in the care plan (nursingmidwiferyboard.gov.au,
2018). Adherence to these aspects in the given video will be discussed in a Gibbs reflective
cycle as below:
Description:
The event took place in a hospital inpatient ward, involving a patient (middle aged
male) and a nurse, as a part of a regular nursing visit. The nurse came in to check the vital
signs of the patient, performing assessment of the patient’s condition and state of mind. At
the end of the video, the patient seemed to be comfortable with the nurse, as the nurse

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completed his assessment and assured the patient that the readings were positive, which he
will share with the doctor (Youtube.com, 2018).
Reflection:
Upon viewing the video, I found several aspects in which the nurse failed to conduct a
comprehensive assessment of the patient to properly understand the health status of the
patient. The assessment done by the nurse was very brief, as he checked the temperature
using a thermometer and the pulse of the patient. However, it was seen that the patient got
startled when the nurse tried to use the thermometer on the patient’s ear. The nurse could
have informed how the thermometer works, and sought permission from the patient before
inserting it into the ear. This showed that the nurse did not give importance to the experiences
of the patient. Moreover, the tests were not holistic as the nurse did not perform any other
tests apart from checking the vital signs and pulse, which lacked a significant range in the
assessment. However, the nurse did ask how the patient was feeling, which was a good step
towards the assessment of the perceived health status of the patient. The patient did mention
that he was feeling a lot better, but still not at a 100%. At this point, it could have been useful
for the nurse to further check with the patient, what difficulties he facing that was made him
feel less than a 100%. The nurse also conducted the test alone, and there did not seem to be
any evidence of an effective healthcare partnership from the video, and neither was the nurse
involved in the planning of patient’s care. I believe that the nurse was not able to properly
exhibit adherence to the standard 4 of NMBA and NCAS (Wilson et al., 2016; Giger, 2016).
Evaluation:
In the video, the nurse only briefly checked the vital signs and pulse of the patient,
after asking how he felt.

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What was good about the experience: The nurse utilized a thermometer to check the
temperature and the pulse was checked from the radial artery.
What was bad about the experience: Comprehensive assessment however includes
the assessment of several factors, which are needed to understand the overall health and
wellbeing of the patient. The nurse however did ask the patient how he felt, which was an
important strategy, as it allowed the patient to express his perception of self health. Asking
about the health as an open ended question also provides opportunity for the patient to raise
any concerns relating to his/her health, which can thus be addressed by the healthcare
professionals (youtube.com, 2018).
My Judgment on the incident: Assessment for vital signs should include the
respiration rate, blood pressure, oxygen saturation and pain apart from just the temperature
and pulse rate (or heart rate). The respiratory rate, blood pressure and oxygen saturation can
help to understand the respiratory and circulatory performance and pain assessment can be
helpful to understand if the patient is feeling any pain or discomfort (Forbes & Watt, 2015).
Additionally, the weight and blood sugar level of the patient can also be assessed in the
routine checkup. Physical assessments can also be done by observation, inspection, palpation,
percussion and asciculation (Morton et al., 2017; Wald et al., 2018). However none of such
assessment strategies were used by the nurse in the video.
What didn’t go so well and how the nurse contributed to the situation: Not
checking these factors by the nurse was thus a non compliance to the standard 4 of the
NMBA, as the assessment done by the nurse was non comprehensive and non-holistic.
However, it is crucial that a thorough and holistic assessment should be done on the patient
during the nursing visits, as it can help to understand the status of the patient’s health and

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well being, and also help to predict any possible complications or identify clinical signs in a
better manner (nursingmidwiferyboard.gov.au, 2018).
Analysis:
Analysis of the video showed several components and aspects that went well and
many others that did not, in contrast to the standard 4 of the NMBA and NCAS.
What went well: Only a few things could be identified to have gone well in the
video, this included the checking of the vital signs and pulse which was done efficiently by
the nurse.
What did the others do well: NA
What went wrong: Many other tests were completely sidelined. The nurse was
unable to conduct a holistic assessment of the patient.
What didn’t turn up the way it was supposed to: Assessment for vital signs did not
include checking the blood pressure, blood glucose, oxygen saturation and pain levels.
Physical assessment of the patient also was not done which could have included checking the
skin, nutrition and hydration status, disabilities as well as assessment of risks. More focused
assessment could have been done to check neurological, respiratory, cardiovascular,
gastrointestinal, renal, musculoskeletal, integumentary performance as well as Eye, ear nose
throat assessment. The nurse instead checked the body temperature and pulse of the patient
(Wald & Garber, 2018; Forbes & Watt, 2015; Giger, 2016).
Who and what contributed to how things turned up: The lack of experience of the
nurse resulted in such overlooks.
Conclusion:

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A holistic and comprehensive assessment of health is vital to understand the health
status of the patient. The standard 4 of the NMBA implies the necessity for conducting
assessments comprehensively by the nurses. According to Lysdahl et al. (2017) using various
technologies in assessment can help to better understand complex conditions. Chitsabesan et
al. (2015) pointed out that a holistic assessment can also help to develop specialist services
for the clients, and thus achieve better healthcare outcomes. Thus, information from detailed
assessment can be useful for making better clinical decisions (Couët et al., 2015). A holistic
approach can also help to better understand and identify early warning signs and avoid
complications (Morton et al., 2017).
From the video, I was able to understand that a significant development in clinical
skills is needed to ensure adherence to standard 4 of NMBA. This includes the ability to
utilize different methods of assessments, which can check the overall state of health and well
being of the patient and to identify any early warning signs. Development of clinical and
diagnostic skills can be improved through such a clinical competency.
Action Plan:
Goal Action Evaluation
Conducting a comprehensive
health assessment
1. Assessment of Vital
Signs: Body
temperature,
respiratory rate, heart
rate, blood pressure,
oxygen saturation and
pain levels.
2. Physical Assessment
Evaluation of the various types
of assessments can be
conducted using various
equipments, depending on the
type of assessments. The
efficacy of these tools can be
exhibited by the accuracy of the
information provided by the

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(additional): weight,
blood sugar.
3. Assessment of
nutrition and
hydration
4. Risk assessment
5. Assessment of
Nutrition,
elimination, sensory
function,
musculoskeletal
performance,
integumentary status,
neurological function,
dental condition, oral
hygiene,
physiological
assessment,
medications and
treatment and safety
needs of the patient.
tools.

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References:
Chitsabesan, P., Lennox, C., Williams, H., Tariq, O., & Shaw, J. (2015). Traumatic brain
injury in juvenile offenders: findings from the comprehensive health assessment tool
study and the development of a specialist linkworker service. The Journal of head
trauma rehabilitation, 30(2), 106-115.
Couët, N., Desroches, S., Robitaille, H., Vaillancourt, H., Leblanc, A., Turcotte, S., ... &
Légaré, F. (2015). Assessments of the extent to which health‐care providers involve
patients in decision making: a systematic review of studies using the OPTION
instrument. Health Expectations, 18(4), 542-561.
Forbes, H., & Watt, E. (2015). Jarvis's Physical Examination and Health Assessment.
Elsevier Health Sciences.
Giger, J. N. (2016). Transcultural Nursing-E-Book: Assessment and Intervention. Elsevier
Health Sciences.
Husebø, S. E., O'Regan, S., & Nestel, D. (2015). Reflective practice and its role in
simulation. Clinical Simulation in Nursing, 11(8), 368-375.
Lysdahl, K. B., Mozygemba, K., Burns, J., Brönneke, J. B., Chilcott, J. B., Ward, S., &
Hofmann, B. (2017). Comprehensive assessment of complex technologies: integrating
various aspects in health technology assessment. International journal of technology
assessment in health care, 33(5), 570-576.
Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a
holistic approach (p. 1056). Lippincott Williams & Wilkins.

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nursingmidwiferyboard.gov.au (2018), Registered nurse standards for practice, retrieved on
25 May, 2018, from:
http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?
record=WD16%2F19524&dbid=AP&chksum=R5Pkrn8yVpb9bJvtpTRe8w%3D%3D
Wald, A., & Garber, C. E. (2018). A Review of Current Literature on Vital Sign Assessment
of Physical Activity in Primary Care. Journal of Nursing Scholarship, 50(1), 65-73.
Wilson, S. F., & Giddens, J. F. (2016). Health Assessment for Nursing Practice-E-Book.
Elsevier Health Sciences.
youtube.com (2018), NRSG139 Ax3 TPRVignette, retrieved on: 25 May, 2018, from:
https://www.youtube.com/watch?v=550mSnqtqRA&feature=youtu.be